Vascular

Brachial Embolectomy

OPERATION: Brachial Embolectomy
ANAESTHETIC: General / regional / local anaesthesia
POSITION: Supine, affected arm on arm board. Skin prepared from neck to hand. Fogarty catheters — multiple sizes available. Heparin 5000 IU administered on diagnosis.

INDICATION:
Acute upper limb ischaemia — embolic in origin. [Underlying cause: atrial fibrillation]. Heparin administered on diagnosis.

PROCEDURE:
WHO Checklist performed. 8-10 cm lazy-S incision from medial biceps, curving over the antecubital fossa, extending into the groove between brachioradialis and flexor muscles. Brachial artery and its bifurcation into radial and ulnar arteries dissected and slung. Bicipital aponeurosis partially / completely divided for access.

ARTERIOTOMY:
Clamps on brachial, radial, and ulnar arteries. Transverse arteriotomy just proximal to bifurcation. Proximal inflow confirmed. Distal back-bleeding assessed.

FOGARTY EMBOLECTOMY:
Fogarty catheter (size 3-4) passed selectively into radial then ulnar arteries. Balloon inflated and catheter trawled proximally retrieving thrombus. [If inflow poor: size 4-5 catheter passed proximally.] Repeated until no further clots. Vessels flushed with heparinised saline.